Predicting Methicillin Resistance and the Effect of Inadequate Empiric Therapy on Survival in Patients With Staphylococcus aureus Bacteremia

Roghmann, Mary-Claire

doi:10.1001/archinte.160.7.1001

Cited by 114 publications

(59 citation statements)

References 16 publications

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“…While this may translate into improved clinical outcomes, especially in those in whom MRSA is undetected and who have been treated empirically with a beta-lactam antibiotic, small studies have failed to demonstrate the benefit of early appropriate therapy (1,18).…”

Section: Discussionmentioning

confidence: 99%

Methicillin-Resistant Staphylococcus aureus : Comparison of Susceptibility Testing Methods and Analysis of mecA -Positive Susceptible Strains

et al. 2001

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Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for an increasing number of serious nosocomial and community-acquired infections. Phenotypic heterogeneous drug resistance (heteroresistance) to antistaphylococcal beta-lactams affects the results of susceptibility testing. The present study compared the MRSA-Screen latex agglutination test (Denka Seiken Co., Ltd., Tokyo, Japan) for detection of PBP 2a with agar dilution, the VITEK-1 and VITEK-2 systems (bioMérieux, St. Louis, Mo.), and the oxacillin agar screen test for detection of MRSA, with PCR for the mecA gene used as the "gold standard" assay. Analysis of 107 methicillin-susceptible S. aureus (MSSA) isolates and 203 MRSA isolates revealed that the MRSA-Screen latex agglutination test is superior to any single phenotype-based susceptibility testing method, with a sensitivity of 100% and a specificity of 99.1%. Only one isolate that lacked mecA was weakly positive by the MRSA-Screen latex agglutination test. This isolate was phenotypically susceptible to oxacillin and did not contain the mecA gene by Southern blot hybridization. The oxacillin agar screen test, the VITEK-1 system, the VITEK-2 system, and agar dilution showed sensitivities of 99.0, 99.0, 99.5, and 99%, respectively, and specificities of 98.1, 100, 97.2, and 100%, respectively. The differences in sensitivity or specificity were not statistically significant. Oxacillin bactericidal assays showed that mecA-and PBP 2a-positive S. aureus isolates that are susceptible to antistaphylococcal beta-lactams by conventional methods are functionally resistant to oxacillin. We conclude that the accuracy of the MRSA-Screen latex agglutination method for detection of PBP 2a approaches the accuracy of PCR and is more accurate than any susceptibility testing method used alone for the detection of MRSA.

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Section: Discussionmentioning

confidence: 99%

Methicillin-Resistant Staphylococcus aureus : Comparison of Susceptibility Testing Methods and Analysis of mecA -Positive Susceptible Strains

et al. 2001

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“…9 It is therefore necessary to make informed decisions regarding selection of empirical antibiotics. [10][11][12][13] Consideration of a patient's previous colonization status is important, because colonization predates most hospital and community-acquired infections. 10,14 Universal or targeted surveillance for MRSA has been implemented widely as a means of limiting transmission of this antibiotic-resistant pathogen.…”

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confidence: 99%

“…[10][11][12][13] Consideration of a patient's previous colonization status is important, because colonization predates most hospital and community-acquired infections. 10,14 Universal or targeted surveillance for MRSA has been implemented widely as a means of limiting transmission of this antibiotic-resistant pathogen. 15,16 Although results of MRSA screening are not intended to guide empirical treatment, they may offer an additional benefit among patients in whom clinical infection with S. aureus develops.…”

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confidence: 99%

Utility of prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections

MacFadden

Elligsen

Robicsek

et al. 2013

CMAJ

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“…Early and appropriate treatment of septicemia has been associated with a reduction in the rate of mortality (1, 9, 11). However, one study reported that although patients with MRSA bacteremia were less likely to receive effective antibiotic therapy, this was not significantly linked to an increased rate of mortality (22).…”

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confidence: 99%

Rapid Identification of Methicillin-Resistant Staphylococcus aureus from Positive Blood Cultures by Real-Time Fluorescence PCR

et al. 2001

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Methicillin-resistant Staphylococcus aureus septicemia is associated with significant morbidity and mortality and requires treatment with intravenous glycopeptides. For blood cultures positive for gram-positive cocci, 24 to 48 h is required for the detection of S. aureus bacteremia and the provision of antibiotic susceptibility testing results. We describe a molecular biology-based assay that requires 2 h from the time of initial positivity of blood cultures. The assay correctly detected 96% of the S. aureus isolates including all methicillin-resistant S. aureus isolates. Clinical data collected during the study suggest that 28% of patients with S. aureus bacteremia do not receive early and appropriate treatment and that 10% of patients may initially be receiving inappropriate glycopeptide treatment.Staphylococcus aureus septicemia is associated with a mortality rate of 15 to 30% (17). The increasing proportion of infections caused by methicillin-resistant S. aureus (MRSA) (8) has resulted in the widespread empirical use of glycopeptides, which increases the pressure for selection of vancomycin resistance (19,24). The use of vancomycin also requires therapeutic monitoring (15) to reduce the potential for use of a suboptimal dosage (5, 10) and side effects. From the time that a blood culture is positive, conventional methods of culture and antibiotic susceptibility testing require 48 h for the detection of S. aureus bacteremia and the provision of antibiotic susceptibility testing results. Rapid identification of MRSA from blood cultures would accelerate the diagnosis of S. aureus bacteremia and reduce the level of empirical use of vancomycin.This paper reports on a method for the detection of S. aureus and MRSA directly from positive blood cultures by rapid real-time fluorescence PCR and also attempts to measure the potential clinical impact of the more rapid provision of test results.BACTEC 9240 (Becton Dickinson, Le Pont de Claix, France) blood culture bottles were inoculated with 5 to 10 ml of blood from patients with suspected bacteremia and were incubated in the BACTEC 9240 automated continuous monitoring system. When a positive growth index was achieved, aliquots of blood were taken from 141 positive blood cultures showing gram-positive cocci in clusters for culture and PCR.Clinical data were requested from the clinicians directly involved in the care of the patient. All isolates of S. aureus were considered clinically significant. Coagulase-negative staphylococci (CoNS) were considered clinically significant if all of the following factors were present: (i) the patient had had multiple episodes of bacteremia (26); (ii) intravascular catheters, prosthetic heart valves, or other risk factors were present in situ (13,25

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Predicting Methicillin Resistance and the Effect of Inadequate Empiric Therapy on Survival in Patients With Staphylococcus aureus Bacteremia

Cited by 114 publications

References 16 publications

Methicillin-Resistant Staphylococcus aureus : Comparison of Susceptibility Testing Methods and Analysis of mecA -Positive Susceptible Strains

Methicillin-Resistant Staphylococcus aureus : Comparison of Susceptibility Testing Methods and Analysis of mecA -Positive Susceptible Strains

Utility of prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections

Rapid Identification of Methicillin-Resistant Staphylococcus aureus from Positive Blood Cultures by Real-Time Fluorescence PCR

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